tbuckley/cabot-search huggingface dataset:
Abstract P264: Interleukin-1 β Mediation of Chronic Stress-Related Neural Activity and Trimethylamine- N-oxide - Data From the Washington DC Cardiovascular Health and Needs Assessment
Authors: Manuel Cintron, Lola Ortiz-Whittingham, Yvonne Baumer, Nicole Farmer, Billy Collins, Gwenyth Wallen, Tiffany M Powell-Wiley
Journal: Circulation (2023)

Introduction: Chronic stress is a cardiovascular disease (CVD) risk factor but the mechanisms by which it promotes CVD are unclear. Chronic stress can affect amygdalar activity (AmygA), leading to increased levels of activity. We evaluated mediators of the relationship between chronic stress-related amygdalar activity (AmygA) and trimethylamine n-oxide (TMAO), a cardiovascular risk marker. Hypothesis: IL-1 β mediates the association between amygdalar activity and TMAO. Methods: 60 African American adults (93% female, mean age 61±11 years) at risk for CVD living in the Washington DC area participated in a cross-sectional, community-focused study. Participants had a 18 FDG PET/CT to assess chronic stress-related AmygA, phenotyping, and ELISA-based techniques to measure serum cytokines and TMAO. Multivariable regression analyses adjusted for atherosclerotic cardiovascular disease (ASCVD) 10-year risk score and body mass index (BMI) identified associations between AmygA and TMAO. IL-1 β, TNF-α, IL-6, IL-8, IL-17 and IFN-γ were evaluated as mediators of indirect associations between AmygA and TMAO. Results: Multivariable regression modeling revealed significant associations between AmygA and TMAO (β=0.32, p=0.02), AmygA and IL-1 β (β=0.36, p=0.003), and IL-1 β and TMAO (β=0.39, p=&lt;0.001) in the fully adjusted model. IL-1 β mediated the AmygA and TMAO relationship (mediation effect = 43.51%). Conclusions: Chronic stress measured by AmygA directly associates with TMAO, a CVD risk biomarker. This relationship is mediated by IL-1 β, suggesting the potential for chronic stress-related inflammation in the brain-gut axis potentially influencing CVD in underserved communities. These hypothesis-generating results should be studied further in the future by including large, diverse populations.
Abstract P245: Early Pregnancy Exposure to Per- And Polyfluoroalkyl Substances and Thyroid Function Throughout Gestation: A Longitudinal Study
Authors: Anna Birukov, Ruijin Lu, Guoqi Yu, Yan Qiao, Mohammad Rahman, Qi Sun, Ronald C Ma, Zhen Chen, Frank B Hu, Cuilin Zhang
Journal: Circulation (2023)

Introduction: Thyroid function during pregnancy is pivotal for both maternal and fetal health. Data on environmental determinants of thyroid function in pregnancy are yet limited. We prospectively investigated associations of early pregnancy per- and polyfluoroalkyl substances (PFAS), known environmental endocrine disruptors, with thyroid function longitudinally measured throughout pregnancy. Hypothesis: Early pregnancy PFAS exposure adversely affects thyroid function. Methods: Within the NICHD Fetal Growth Studies-Singleton Cohort, we enrolled 2,802 pregnant women at gestational weeks (gw) 10-14 and measured concentrations of 9 PFAS (NMeFOSAA, PFDA, PFDoDA, PFDS, PFHpA, PFHxS, PFNA, PFOA, PFOS, PFOSA, PFUnDA) in plasma samples collected at enrollment. In a subsample of 321 pregnant women, we determined thyroid markers (fT3, fT4, TSH) at gw 10-14, 15-26, 23-31, 33-39. Associations were assessed with multivariable regressions per standard deviation increase in ln-transformed PFAS (ng/ml), adjusting for age, body mass index, diet, lifestyle and socio-economic factors, and plasma lipids. Results: Plasma PFAS in early pregnancy were associated with markers of thyroid function throughout pregnancy. The associations varied by gestational age. Higher levels of several PFAS were associated with lower TSH and higher fT3 and fT4 levels at gw 10-14. Adjusted beta coefficients [95%CI] with TSH (mIU/L) were: -1.13 [-2.30, 0.05] for PFOS, -3.15 [-4.45, -1.86] for PFDA, -1.75 [-2.95, -0.55] for NMeFOSAA, -1.68 [-3.00, -0.37] for PFNA, -1.29 [-2.62, 0.03] for PFDoDA, -2.07 [-3.30, -0.83] for PFOA, but 1.11 [0.12, 2.09] for PFHxS. Most of these associations were attenuated to non-significant or changed the direction of the association in later pregnancy (for instance, PFOS-TSH association at gw 10-14: -1.13 [-2.30, 0.05], gw 15-26: 0.98 [0.18, 1.78], gw 23-31: 1.31 [0.50, 2.13], PFDA-TSH association at gw 10-14: -3.15 [-4.45, -1.86], at gw 23-31: 1.13 [0.16, 2.11]). Consistent and positive associations across pregnancy were observed for PFOA-fT3 (at gw 10-14: 0.48 [0.05, 0.91], gw 15-26: 0.41 [0.04, 0.78], gw 23-31: 0.42 [0.02, 0.80] pmol/L) and PFHxS-fT4 (at gw 10-14: 0.12 [0.02, 0.21], gw 15-26: 0.67 [0.54, 0.81], gw 23-31: 0.22 [0.12, 0.33], gw 33-39: 0.14 [0.02, 0.26] ng/dL). Conclusions: Plasma levels of selected PFAS congeners in early pregnancy are significantly associated with thyroid markers in pregnancy. The associations varied by gestational timing. These findings indicate a potential environmental impact on thyroid function. In perspective, multiple assessments of PFAS and thyroid markers throughout pregnancy might be necessary and relevant for conducting gestational age-specific interventional trials.
Abstract MP76: The Association Between Sleep Health and Gestational Weight Gain
Authors: Marquis S Hawkins, Darya Pokutnaya, Lisa M Bodnar, Michele Levine, Daniel Buysse, Esa M Davis, Meredith L Wallace, Scott Rothenberger, Phyllis Zee, William Grobman, Kathryn J Reid, Francesca Facco
Journal: Circulation (2023)

Background: Poor sleep health is associated with weight gain and obesity outside of pregnancy. Still, there is little research regarding the impact of sleep health on weight among pregnant populations, particularly using a multidimensional sleep-health framework. This study examined associations between mid-pregnancy sleep health indicators, multidimensional sleep health, and gestational weight gain (GWG). Methods: This was a secondary data analysis of the Nulliparous Pregnancy Outcome Study: Monitoring Mothers-to-be Sleep Duration and Continuity Study (n=745). Indicators of individual sleep health domains (i.e., regularity, nap duration, timing, efficiency, and duration) were assessed via actigraphy between 16 and 21 weeks of gestation. We defined “good” sleep health in each domain based on empirical thresholds. Multidimensional sleep health was based on sleep profiles derived from latent class analysis. Total GWG, the difference between self-reported pre-pregnancy weight and the last measured weight before delivery, was converted to z-scores using gestational age- and BMI-specific charts. GWG was defined as low (&lt;-1 SD), moderate (-1 or +1 SD), and high (&gt;+1 SD). Results: We identified four distinct sleep profiles (Figure 1). While indicators of individual sleep domains were not associated with GWG, multidimensional sleep health was associated with higher risk of low GWG. Compared to people with a good sleep profile (Class 1), people with a low efficiency and long sleep duration profile (Class 4) had a 1.88 (95% CI 1.04 to 3.39) higher risk of low GWG (vs. moderate GWG) in models adjusting for education, depressive symptoms, race, smoking status. Discussion: Multidimensional sleep health was more strongly associated with GWG than were individual sleep domains. Future research should determine whether sleep health is a useful intervention target for optimizing GWG. Figure 1- Probabilities of each sleep characteristic by sleep profile, derived from latent class analysis
Abstract P369: Using Machine Learning to Predict Unplanned Readmission Due to Cardiovascular Disease Among Hospitalized Patients With Cancer
Authors: Chanhyun Park, Sola Han, Boon Peng Ng
Journal: Circulation (2023)

Background: Cardiovascular disease (CVD) morbidity and mortality rates have risen in cancer patients. We aimed to demonstrate the feasibility of a using machine learning technique in predicting the risk of unplanned readmission due to CVD among hospitalized cancer patients. Methods: We included hospitalized patients with a primary diagnosis code for any cancer for the index hospitalization using the 2017-2018 Nationwide Readmissions Database. The outcome was unplanned hospital readmission due to any CVD within 180 days after discharge. CVD included atrial fibrillation, coronary artery disease, heart failure, stroke, peripheral artery disease, cardiomegaly, and cardiomyopathy. The original data was separated into training (80%) and testing (20%) data. Decision tree (DT) and three ensemble algorithms, including random forest (RF), extreme gradient boost (XGBoost), and AdaBoost, were implemented. Accuracy, precision, recall, F2 score, and receiver operating characteristic curve (AUC) were used to assess the model’s performance. Each algorithm's feature importance was obtained. Results: Among 358,629 hospitalized patients with cancer, 5.86% (n=21,021) experienced unplanned readmission due to any CVD. The XGBoost indicated the highest AUC at 0.76, followed by the AdaBoost (AUC=0.75) and RF (AUC=0.75), while the DT had the lowest score at 0.72. Similarly, the XGBoost had the highest F2 score of 0.36, followed by the AdaBoost (F2=0.35) and RF (F2=0.35), whereas the DT had the lowest score at 0.33. The AdaBoost demonstrated the highest accuracy and precision while having the lowest recall (Figure). The feature importance plot of the XGBoost identified Medicare enrollment, mortality risk, private insurance, and cancer surgery as top importance features for unplanned readmission due to CVD. Conclusions: Machine learning models can predict the risk of unplanned readmission due to CVD among hospitalized cancer patients. The three ensemble algorithms outperformed the DT, with the XGBoost displaying the best performance.
Abstract 68: Interleukin-6, Diabetes and Metabolic Syndrome in a Biracial Cohort: The Reasons for Geographic and Racial Differences in Stroke (REGARDS)
Authors: Brittney Palermo, Katherine Wilkinson, Tim B Plante, Charles D Nicoli, Suzanne E Judd, Debora Kamin Mukaz, Leann Long, Nels C Olson, Mary Cushman
Journal: Circulation (2023)

Background: Type 2 diabetes mellitus (DM) is more common in Black than White adults in the US. The inflammatory cytokine interleukin-6 (IL-6) is implicated in DM pathogenesis and circulates at higher levels in Black people. Metabolic syndrome (MetS), a group of conditions related to insulin resistance, often precedes or coexists with DM. Little evidence is available on associations of IL-6 with these disorders in Black people. Methods: REGARDS enrolled 30,239 Black and White adults in 2003-07 and conducted a follow up visit 9.5 years later. Baseline IL-6 was measured in a sample of 4,400 participants (equal by race/sex groups) attending both visits. Modified Poisson regression estimated relative risk (RR) by level of baseline IL-6 for incident DM among those without prevalent DM; similar analyses were conducted for MetS. Inverse odds weighting estimated the percent mediation of the racial disparity in incident DM by IL-6. Results: Incident DM occurred in 460/3,399 (14%) at risk, and there were 384/1,957 (20%) cases of incident MetS. As shown in the Figure , DM and MetS incidence increased across baseline IL-6 quartiles overall, with a steeper rise and higher incidence among Black than White adults. Adjusting for confounders, the RR of DM for IL-6 in the 4 th vs 1 st quartile was 1.91 (95% CI 1.38-2.65). Higher IL-6 was also associated with MetS (RR 1.65 (95% CI 1.22-2.22)). In adjusted models there were no material differences in these associations by race. The RR of DM in Black compared with White people was 1.90 (95% CI 1.59-2.27); there was no association of race with MetS. IL-6 significantly mediated 13.4% of the racial disparity in DM adjusting for demographic factors. Conclusions: Higher IL-6 is a risk factor for incident DM and MetS in Black and White adults. The race disparity in DM was partly mediated by IL-6. Interventions to reduce IL-6 may lower risk of DM and MetS and lessen the racial disparity in DM. Figure: Diabetes and Metabolic Syndrome Incidence (bars) and Relative Risk (95% CI) by Baseline IL-6 Quartile
Abstract P353: Association of United States Nativity With Cardiovascular Health Among Race and Ethnic Groups
Authors: Michael M Hammond, Cheryl Mensah, Ruth-Alma N Turkson-Ocran, Sadiya S Khan, Nilay S Shah
Journal: Circulation (2023)

Introduction: Lived experiences based on self-identified race and ethnicity or place of birth are important determinants of cardiovascular health (CVH). However, the association of US nativity with CVH among different race and ethnic subgroups is not well studied. Hypothesis: We hypothesized that CVH will be higher among adults born outside the US compared with adults born in the US. Methods: We included participants aged ≥18 years from the National Health Interview Survey from 2011 through 2018. CVH was calculated based on 5 available metrics: hypertension, diabetes, cholesterol, smoking, and body mass index calculated from self-reported height and weight. Scores ranged from 0 (low CVH) to 10 (high CVH). Nativity was classified as born in or outside the US. Survey-weighted linear regression models examined the association between CVH and US nativity, adjusting for age and sex and stratified by race and ethnic subgroups. Results: Of 117,894 participants (representing 120,295,032 US adults), 51% were female and the mean (SE) age was 45 (0.1) years. Overall, among all combined race and ethnic subgroups, participants born outside the US had significantly higher CVH compared with participants born in the US (beta +0.42; 95% CI: +0.38, +0.46). Hispanic adults (beta +40; 95% CI: +0.32, +0.49), Non-Hispanic Black adults (beta +0.89; 95% CI: +0.77, +1.01), Non-Hispanic Asian adults (beta +0.39; 95% CI: +0.24, +0.54), and Non-Hispanic White adults (beta +0.36; 95% CI: +0.28, +0.45) all had significantly higher CVH compared with adults who were born in the US. The age-and sex-adjusted CVH scores by U.S. nativity for overall race and ethnic groups, Hispanic American subgroups, and Asian American subgroups are shown in the Figure. Conclusion: Overall CVH is significantly higher among people born outside the US compared with those born in the US. Among race and ethnic subgroups, people born outside the US had higher CVH compared with those born within the US, except for Asian Indian adults. Figure. Age-and-sex adjusted CVH scores by US nativity.
Abstract P252: Financial Strain and Cardiovascular Health Among Young Black Women: Findings From a Community Survey
Authors: Anika L Hines, Allison Auten, Darrell Gaskin
Journal: Circulation (2023)

Background: Black women experience disproportionate rates of cardiovascular disease (CVD), including earlier onset, increased number of risk factors, and higher morbidity rates. Higher levels of stress may help to explain this disparity. We sought to examine the relationship between financial strain—a common stressor—and cardiovascular health in a sample of young, Black women. Methods: We performed a cross-sectional analysis of data collected through an academic-community collaboration with the AME Zion Church. In 2019, an electronic survey was administered to self-identified Black women aged 18 to 40 years. The survey assessed psychosocial stressors, psychological distress, healthcare utilization, and health status. We examined the association of financial strain—defined as difficulty in paying for necessities—and cardiovascular health (CVH) modeled after the American Heart Association’s “Life’s Essential 8”. The eight domains were defined by four behavioral health factors (sleep, diet, physical activity, and smoking) and four self-reported health conditions (overweight/obesity, prediabetes/diabetes, high blood pressure, and high cholesterol). Each component earned 1 point for positive attributes (e.g., adequate sleep) or 0 for negative attributes (e.g., having high blood pressure). Components were summed to a total score (range: 0-8). We used multivariable regression to examine the relationship between financial strain and CVH score adjusting for other sociodemographic factors. Results: This study included 160 Black women with a mean age of 32.36 (SD = 5.68). Nearly half the sample (46%) held graduate or professional degrees, and 28% of respondents earned an income ≥$100,000. The mean score on the 8-point CVH measurement was 5.45 (SD=1.44). Adjusting for age, education, and income, experiencing some financial strain was associated with poorer CVH than little to no financial strain (β = -0.72, p=.006). Age was marginally associated with decreasing CVH (β=-.040, p=0.05). Evaluating individual CVH components, those with some degree of financial strain had higher odds of being sedentary (OR: 2.29; 95% CI: 1.04, 5.04) and getting insufficient sleep (OR: 2.66; 95% CI: 1.17, 6.05) than those with little to no strain. There were no significant associations between financial strain and diet or the health status measures (i.e., overweight/obesity, prediabetes/diabetes, high blood pressure, high cholesterol). Smoking could not be evaluated separately due to low numbers of smokers within the sample. Conclusion: Adjusting for age, education, and income, financial strain was negatively associated with overall CVH, and physical activity and sleep, specifically, within this sample of young, Black women. Interventions targeting financial strain may positively affect preventative CVH behaviors within this population.
Abstract P115: Ethnic Differences in Cardiovascular Disease Deaths Among African American, African Immigrant and Afro-Caribbean Adults in the 1999-2018 National Health Interview Surveys
Authors: Oluwabunmi V Ogungbe, Ruth-Alma Turkson-Ocran, Diana-Lyn Baptiste, Fredrick Larbi Kwapong, Emily Aidoo, Yvonne Commodore-Mensah, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Background: Black persons are an heterogenous group in the US and bear a disparate higher burden of worse cardiovascular disease (CVD) outcomes. Our objective was to examine ethnic differences in CVD mortality among Black subgroups; African Americans(AAs); African Immigrants(AIs); and Afro Caribbeans(ACs). Methods: We analyzed the 1999-2018 National Health Interview Survey data, prospectively linked to mortality records in the National Death Index on 23,169,679 Black adults. The outcomes was CVD mortality, defined as CVD and cerebrovascular deaths, which was modelled as time till death (in years). This was calculated from each survey year till time of death or December 31, 2019 (administrative censoring) for those who survived. Using multivariable Cox proportional hazards regression analyses to model the survival function, we evaluated differences in CVD-and cerebrovascular-cause specific deaths among the three groups with progressive adjustment for age, sex, socioeconomic status and CVD risk factors. Results: With median of 10 years of mortality follow-up, there were 2.44, and 1.86 CVD deaths per 1,000 person-years among AA, and foreign born black adults (AIs and ACs combined), respectively. CVD mortality hazard was 81% lower in AIs [hazard ratio [HR], 0.19 (95% CI, 0.13–0.29], Table ) and 54% lower in ACs [HR, 0.46 (95% CI, 0.40–0.53], than among AAs. Compared to AAs, age-and sex-adjusted CVD mortality hazard was lower among AIs by 66% [HR, 0.34 (95% CI, 0.23–0.51], Table ) and ACs (HR, 0.46 [95% CI, 0.40–0.53]) by 54% (unchanged from unadjusted). In the fully adjusted model with SES and CVD risk factors adjustment, ACs had 41% lower adjusted CVD mortality hazard than AA adults (HR, 0.59 [95% CI, 0.45–0.77]). Conclusions: Cardiovascular deaths were higher among US-born AAs than foreign-born ACs. Nativity status is an important determinant of CVD mortality, and the heterogeneity of this population should be considered in health disparities research and interventions.
Abstract P634: Life’s Essential 8 and the Role of Sleep in Atherosclerotic Cardiovascular Disease: Coronary Artery Risk Development in Young Adults (CARDIA) Study and Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Hongyan Ning, Donald Lloyd-Jones, Amanda M Perak, Darwin R Labarthe, Philip Greenland, Norrina B Allen
Journal: Circulation (2023)

Introduction: Sleep affects other cardiovascular health (CVH) behaviors and factors, and it is associated with cardiovascular disease. The AHA recently updated the definition of CVH to include sleep (“Life’s Essential 8”; LE8). Associations of the LE8 CVH score (with or without sleep) with atherosclerotic cardiovascular disease (ASCVD) risk have not been described. Methods: We included CARDIA and MESA participants (ppts), stratified into younger (ages 30-45, n=4332), middle-aged (ages 45-60, n=4793), and older groups (ages 60-75, n=3168). CVH score (range: 0-100) with sleep (8 metrics) and without sleep (7 metrics) was scored separately and categorized by age-specific quartiles. Reclassification of CVH score with the addition of sleep and associations with ASCVD events were assessed at each age. Results: Mean (SD) CVH scores with and without sleep were 72.8 (13.2) and 73.0 (14.2) for younger, 67.1 (14.6) and 65.6 (15.8) for middle-aged, 64.6 (13.6) and 63.0 (14.9) for older ppts. Self-reported Black race and less favorable socioeconomic and psychosocial status were associated with shorter sleep duration, as were lower CVH scores. When sleep was included in the CVH score, 81.9%-83.0% (by age group) of ppts had consistent CVH score quartiles, 7.7%-8.9% were reclassified into a higher CVH score quartile, and 7.8%-9.3% were reclassified into a lower CVH score quartile. Including sleep tended to result in worse CVH scores for men and Black ppts. Higher CVH scores were associated with significantly greater probability of ASCVD-free survival (Figure 1A). Each 10-point higher CVH score was associated with 21%-39% lower hazards for ASCVD across age groups, and the CVH score including sleep had somewhat stronger associations with ASCVD than the CVH score without sleep (Figure 1B). Conclusion: Higher CVH using the LE8 score is associated with lower ASCVD risk. The inclusion of sleep in the CVH score reclassified almost 20% of participants and resulted in somewhat stronger associations between CVH score and ASCVD. Characters: 1730/1750 max allowed Figure 1: Age, sex, race, and education adjusted association of LE8 and ASCVD(A-adjusted ASCVD-free Survival Curves by quartile of CVH score; B-adjusted hazard ratio and 95%CI)